Low Back Pain
by Elizabeth Smoots, MD
Low back pain is an ache or discomfort in the area of the lower part of the back and spinal column. The lower spinal column has many small bones that surround and protect the spinal cord and nerves. Low back pain is very common. It affects most adults at some point in their lives.
There are many possible causes for low back pain. Many times, the exact source of back pain is not known. Some causes of back pain include:
Risk Factors TOP
These factors increase your chance of developing low back pain:
Pain is usually restricted in the low back. It can get worse with back motion, sitting, standing, bending, and twisting. If a nerve is irritated, the pain may spread into the buttock or leg on the affected side. Muscle weakness or numbness may occur.
When Should I Call My Doctor?
Often, back pain improves with self-treatment. However, some serious symptoms may occur. They may require more immediate medical attention. Call your doctor if back pain:
You should call your doctor if you have back pain and a history of cancer or osteoporosis. You should also call if you have a history of steroid use or IV drug use.
The doctor will ask about your symptoms and medical history. A physical exam will be done. The exam will focus on your back, hips, and legs. The doctor may test for strength, flexibility, sensation, and reflexes.
Your doctor may need pictures of your body structures. This can be done with:
It is important to keep in mind that imaging tests, may not be helpful or appropriate right after a back injury.
Your doctor may need your bodily fluids tested. This can be done with:
Your doctor may want to examine your bones using a bone scan.
Treatment options include:
Bed rest is not generally recommended. It may only be advised for not more than 1–2 days in those with severe back pain. Your doctor may recommend that you restrict certain activities for a period of time and then resume them as soon as possible. By staying active and exercising, you may be able to shorten your recovery time.
Medicines that your doctor may suggest include:
A physical therapy program may include:
If you have low back pain, follow your doctor's instructions.
The following steps may help you avoid low back pain:
American Academy of Orthopaedic Surgeons
American Academy of Family Physicians
Canadian Orthopaedic Association
Canadian Orthopaedic Foundation
Acute low back pain. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed . Updated December 3, 2012. Accessed December 6, 2012.
Bratton RL. Assessment and management of acute low back pain. Am Fam Physician. 1999;60:2299-2309.
Chronic low back pain. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/ . Updated November 28, 2012. Accessed December 6, 2012.
Dahm KT, Brurberg KG, Jamtvedt G, Hagen KB. Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica. Cochrane Database Syst Rev . 2010 Jun 16;(6):CD007612.
Hagen KB, Hilde G, Jamtvedt G, Winnem M. Bedrest for acute low back pain and sciatica. Cochrane Database Rev. 2000;CD001254.
Katz JN. Lumbar disc disorders and low-back pain: socioeconomic factors and consequences. J Bone Joint Surg Am. 2006;88 Suppl 2:21.
Patel AT, Ogle AA. Diagnosis and management of acute low back pain. Am Fam Physician. 2000;62:2414-2415.
9/16/2008 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/ : Kalus SM, Kornman LH, Quinlivan JA. Managing back pain in pregnancy using a support garment: a randomised trial. BJOG. 2008;115:68-75. Epub 2007 Nov 12.
12/16/2008 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/ : Furlan AD, Imamura M, Dryden T, Irvin E. Massage for low-back pain. Cochrane Database Syst Rev. 2008;CD001929.
1/30/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/ : Yuan J, Purepong N, Kerr DP, Park J, Bradbury I, McDonough S. Effectiveness of acupuncture for low back pain: a systematic review. Spine. 2008;33:E887-900.
2/17/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/ : Bigos SJ, Holland J, Holland C, Webster JS, Battie M, Malmgren JA. High-quality controlled trials on preventing episodes of back problems: systematic literature review in working-age adults. Spine J. 2009;9:147-168.
2/17/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/ : Chou R, Fu R, Carrino JA, Deyo RA. Imaging strategies for low-back pain: systematic review and meta-analysis. Lancet. 2009;373:463-472.
2/24/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/ : Sahar T, Cohen M, Ne'eman V, et al. Insoles for prevention and treatment of back pain. Cochrane Database Syst Rev. 2009;(1):CD005275.
9/2/2009 DynaMed Systematic Literature Surveillance http://www.ebscohost.com/dynamed/ : Urquhart D, Hoving J, Assendelft W, Roland M, van Tulder M. Antidepressants for non-specific low back pain. Cochrane Database Syst Rev. 2009;(3):CD001703.
11/12/2010 DynaMed's Systematic Literature Surveillance http://www.ebsochost.com/dynamed/ : US Food and Drug Administration. FDA clears Cymbalta to treat chronic musculoskeletal pain. US Food and Drug Administration website. Available at: http://www.fda.gov... . Published November 4, 2010. Accessed November 12, 2010.
12/17/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/ : Andersen LL, Christensen KB, Holtermann A, et al. Effect of physical exercise interventions on musculoskeletal pain in all body regions among office workers: a one-year randomized controlled trial. Man Ther. 2010;15(1):100-104.
10/21/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/ : Chan CW, Mok NW, Yeung EW. Aerobic exercise training in addition to conventional physiotherapy for chronic low back pain: a randomized controlled trial. Arch Phys Med Rehabil. 2011 ;92(10):1681-1685.
11/29/2011 DynaMed's Systematic Literature Surveillance http:www.ebscohost.com/dynamed/ : Gatti R, Faccendini S, Tettamanti A, Barbero M, Balestri A, Calori G. Efficacy of trunk balance exercises for individuals with chronic low back pain: a randomized clinical trial. J Orthop Sports Phys Ther. 2011;41(8):542-552.
Last reviewed November 2012 by Brian Randall, MD
Last Updated: 11/26/2012